With the national health system at a tipping point favoring care focused on patient priorities, it is important for researchers to explore ways to improve patient care, especially for older adults. In a study published today in the Journal of the American Geriatrics Society, researchers at Baylor College of Medicine and the Michael DeBakey VA Medical Center describe ways to make person-centered care—a novel approach to healthcare that puts personal values and preferences at the forefront of decision-making—more actionable for older people.
Though critically important to the quality of care, eliciting and documenting personal values remains uncommon in routine older adult care, particularly for people with multiple health concerns that complicate pinpointing broader health priorities.
A research team led by Dr. Aanand Naik, associate professor and vice chair of medicine at Baylor, and Dr. Lilian Dindo, assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor, describe Patient Priorities Care, a novel process to identify health goals and care preferences for older people with multiple health conditions. For a patient population accustomed to lengthy visits with multiple providers, the process introduced by Naik, Dindo and their colleagues used expertly trained facilitators to help older adults and caregivers work through health priorities sensitively, but in a process that could be completed across just two sessions totaling 45 minutes or less.
“Results of this study demonstrate that healthcare professionals can be trained to perform the patient priorities identification process as part of their clinical encounters in a manner that is rewarding and enjoyable but requires training and formal feedback,” Naik said. Naik and Dindo also are researchers with the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center.
“Making person-centered care a reality for older adults with complex care needs will take time and effort, including significant research to move promising approaches from the lab bench to the clinic,” said Dr. William B. Applegate, editor-in-chief of JAGS. “This work is helping test innovative strategies, which will move us toward a broader and more balanced approach to care while also providing an impetus to reengineer our care systems.”
Person-centered care is achieved through a dynamic relationship among individuals, others who are important to them and all relevant providers. This collaboration informs decision-making to the extent that the individual desires. Many of these attributes are already on display in the work of Naik, Dindo, and their colleagues, pointing to the high value but also the high priority placed on accelerating person-centered care in geriatrics and beyond.
This paper corresponds with another study published today in JAGS titled “Feasibility of Implementing Patient Priorities Care for Patients with Multiple Chronic Conditions.”
Other contributors of this work include Dr. Julia Van Liew, Dr. Natalie Hundt, Lauren Vo, Kizzy Hernandez-Bigos, Jessica Esterson, Mary Geda, Dr. Jonathan Rosen, Dr. Caroline Blaum, and Dr. Mary E. Tinetti. The authors are affiliated with one or more of the following institutions: Baylor College of Medicine, VA Central Iowa Health Care System, Connecticut Center for Primary Care, Yale University, and/or New York University.
This study was supported by grants from the John A. Hartford Foundation, Patient-Centered Outcomes Research Institute, the Gordon and Betty Moore Foundation and the Robert Wood Johnson Foundation. The study team received additional support from the Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN 13–413) at the Michael E. DeBakey VAMC.